Organization
SPARADISE LLC
Active
Other names
Clearwater Escape llc, Fancy Fun
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN CLEARWATER LMT (OWNER)
(360) 606-1694
Entity
Organization
Contact information
Practice address
14602 NE FOURTH PLAIN BLVD STE A, VANCOUVER, WA 98682-5080
(608) 928-1913
Mailing address
14602 NE FOURTH PLAIN BLVD STE A, VANCOUVER, WA 98682-5080
(360) 606-1694
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
12/14/2022
Last updated
12/14/2022
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